Prognostic Value of Lymph Node to Primary Tumor Standardized Uptake Value Ratio in Unresectable Esophageal Cancer

Abstract

Background Unresectable esophageal cancer harbors high mortality despite chemoradiotherapy. Better patient selection for more personalized management may result in better treatment outcomes. We presume the ratio of maximum standardized uptake value (SUV) of metastatic lymph nodes to primary tumor (NTR) in 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography (FDG PET/CT) may provide prognostic information and further stratification of these patients. Methods The patients with non-metastatic and unresectable esophageal squamous cell carcinoma (SCC) receiving FDG PET/CT staging and treated by chemoradiotherapy were retrospectively reviewed. Receiver operating characteristic (ROC) analysis was performed to determine the optimal cut-off value for NTR. Kaplan-Meier method and Cox regression model were used for survival analyses and multivariable analyses, respectively.Results From 2010 to 2016, 96 eligible patients were analyzed. The median follow-up time was 10.2 months (range 1.6 to 83.6 months). Using ROC analysis, the best NTR cut-off value was 0.46 for prediction of distant metastasis. The median distant metastasis-free survival (DMFS) was significantly lower in the high-NTR group (9.5 vs. 22.2 months, p = 0.002) and median overall survival (OS) (9.5 vs. 11.6 months, p = 0.013) was also significantly worse. Multivariable analysis revealed that NTR was an independent prognostic factor for DMFS (hazard ratio [HR] 1.81, p = 0.023) and OS (HR 1.77, p = 0.014).Conclusions High pretreatment NTR predicts worse treatment outcomes and could be an easy-to-use and helpful prognostic factor to provide more personalized treatment for patients with non-metastatic and unresectable esophageal SCC.

The prognostic value of the lymph node ratio in patients with stage IIIC ovarian cancer treated with preoperative chemotherapy

“…The pathogenic factors of ovarian tumors are unclear, but the environmental and endocrine effects are the most important among the pathogenic factors of ovarian tumors. Studies to date have confirmed that the LNR has good predictive value for the prognosis of patients with malignant tumors, including ovarian cancers (12)(13)(14)(15)(16)(17)(18)(19)(20). Preoperative chemotherapy has a certain impact on the lymph node status of patients with malignant tumors.…”

Prognostic value of node-to-primary tumor maximum standardized uptake value ratio in T1-4N1-3M0 non-small cell lung cancer patients treated with concurrent chemo-radiotherapy

“…In their report, multivariable analysis showed that NTR was an independent prognostic factor for distant metastasis-free survival (hazard ratio 2.20, 95% CI 1.20–4.03, P = 0.011). Similarly, it has been demonstrated that NTR was an independent factor for predicting prognosis in unresectable esophageal cancer [10], endometrioid endometrial carcinoma [11], and invasive ductal breast cancer [33]. Kaira et al [34] found that higher ratio of SUVmax of the metastatic tumor to the primary tumor (M/P ratio) portended lower response to initial chemotherapy and poorer survival (PFS and OS) in stage IIIB and IV NSCLC patients [22].…”

“…In addition to these traditional PET parameters, several recent studies investigated the role of a ratio parameter called the ratio of maximum standardized uptake value (SUV) of metastatic lymph nodes to primary tumor (NTR) [9][10][11][12]. Several studies had found that the patients with relatively high NTR are significantly associated with poor outcomes, suggesting that the NTR has different behaviors between tumors with higher and lower metastatic potential [10,12]. However, few studies investigated the prognostic value of NTR in NSCLC patients treated with concurrent chemo-radiotherapy.…”